'Campus care' for psychopaths

A campus-style special hospital to detain up to 2,000 people with dangerous personality disorders is proposed in a white paper, published yesterday, for the biggest shake-up in mental health policy in England and Wales for more than 40 years.

Ministers promised legislation after the next election to establish indefinite detention of people with untreatable personality disorders - formerly known as psychopaths - even if they had never committed any crime.

The white paper also proposed compulsory procedures to ensure that patients living in the community take their medication, and extra safeguards to protect the human rights of vulnerable people. "Reducing the stigma which attaches to people with mental illness should be a priority for any caring, civilised society," said Alan Milburn, the health secretary.

Home Office officials said there were 1,400 dangerous and severely personality disordered people, many in prison, 400 in hospitals and 300-600 living in the community.

Inquiries into the special hospitals at Ashworth and Rampton recommended that such people should not be detained in units larger than 50. But there were likely to be serious difficulties in getting planning approval for up to four units for disordered people.

The government is considering solving the problem by building a "modular" special hospital with clusters of small units. Ministers do not yet have a location in mind.

The white paper said people with personality disorders could not be detained under the Mental Health Act because their condition was considered medically untreatable.

This legal loophole caused public outrage in the case of Michael Stone, who was diagnosed as having a severe personality disorder several years before he bludgeoned Lin Russell and her six-year-old daughter Megan to death as they walked through fields near their home in 1996.

The white paper said there should be powers to detain people for up to 28 days if a doctor decided they had a personality disorder, with futher reviews at six-month intervals.

Mr Milburn said: "At present neither the law nor services are geared to cope with the risks posed by dangerous people with severe personality disorder. There has been a gap in the protection mental health laws should afford the public - a gap we will now close."

The white paper included plans to ensure that mentally ill people living in the community stick to an agreed treatment plan. Those failing to take med ication could be forcibly detained and taken to hospital for treatment. "There will be no powers for patients to be given medication forcibly except in a clinical setting," the paper said in an attempt to reassure mental health charities which feared that patients might be forcibly treated at home.

The proposal followed the case of Anthony Joseph, a mentally ill man who killed a woman after refusing to take his medication.

These extra compulsory powers will be balanced by extra safeguards for patients including a new right to independent advocacy and a statutory requirement to develop care plans. A new commission for mental health will look after the interests of people subject to care and treatment under mental health legislation.

Mr Milburn said the reforms would build on extra investment in mental health, including £300m in the NHS plan in July and national standards making mental health a priority for health authorities.

Cliff Prior, chief executive of the National Schizophrenia Fellowship, said: "The white paper is an early Christmas present for everyone who believes that the time is right to end the Cinderella status of mental health.

"But it is a Christmas present that carries a demand for payment. There can be no buy now, pay later period when it comes to investing in mental health."

The mental health charity Mind claimed a victory in getting the government to drop plans to introduce forced medical treatments in the community.

The National Association for the Care and Resettlement of Offenders said the plan to detain people with personality disorders because of what they might do rather than what they had done was "an excessive reaction to a genuine and legitimate public concern.

"There is a very real danger that wrong diagnoses could lead to some people being detained inappropriately while others who are dangerous may be missed or still pose a risk to the public even after treatment," said Graeme Sandall, its spokesman on mental health.

Liberty, the human rights group, said it was "seriously concerned" by the new criteria for detaining people who had not done anything wrong.

Main points

The white paper, Reforming the Mental Health Act, proposes:

 Indefinite detention of potentially dangerous people with untreatable personality disorders who had not committed a crime;

 powers to force patients living in the community to take their agreed medication;

 an independent tribunal to determine all longer term use of compulsory powers and a patient's right to independent advocacy;

 new rights for victims of crime to know when someone with a mental health disorder was to be released;

 a commission for mental health to look after people who were subject to care and treatment;

 increases in staff and services for people with mental health problems.